gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Long-term results and sagittal alignment after posterior foraminotomy for unilateral cervical radiculopathy

Langzeitergebnisse und sagittales Alignment nach posteriorer Foraminotomie bei lateralem Bandscheibenvorfall der Halswirbelsäule

Meeting Abstract

  • presenting/speaker Mateusz Bielecki - Medical University of Warsaw, Department of Neurosurgery, Warschau, Polen
  • Przemysław Kunert - Medical University of Warsaw, Department of Neurosurgery, Warschau, Polen
  • Artur Balasa - Medical University of Warsaw, Department of Neurosurgery, Warschau, Polen
  • Sławomir Kujawski - Collegium Medicum in Bydgoszcz, Department of Hygiene, Epidemiology, Bromberg, Polen
  • Andrzej Marchel - Medical University of Warsaw, Department of Neurosurgery, Warschau, Polen

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocJM-PSN-01

doi: 10.3205/21dgnc045, urn:nbn:de:0183-21dgnc0452

Veröffentlicht: 4. Juni 2021

© 2021 Bielecki et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Cervical posterior foraminotomy (PF) provide direct decompression of the nerve root, while maintaining cervical mobility by the avoidance of fusion. On the other hand, the posterior approach carries a risk of postoperative segmental instability due to partial facetectomy. The aim of the study was to evaluate the clinical outcomes in correlation with cervical sagittal balance in long term follow up after PF.

Methods: A prospective evaluation of a retrospective cohort of 48 consecutive patients operated on in 2005–2016 was performed. Clinical status was assessed by the Numerical Rating Scale (NRS) and Neck Disability Index (NDI). Sagittal balance was evaluated preoperatively and in follow up by the modified Toyama method, expressed as lordotic, straight or kyphotic alignment. The mean follow-up period was 8.3 years (range: 4.6–14.7 years).

Results: Surgery was performed on one cervical level in 44 (92%) cases, and on two levels in 4 (8%) cases. The mean preoperative NRS for arm and neck pain, and NRS was 8.13 (range: 6 - 10), 5.65 (range: 0 - 10) and 36.58 (range: 12 - 48), respectively. The mean postoperative NRS for arm and neck pain, and NRS was 1.38 (range: 0 - 7), 1.58 (range: 0 - 8) and 11.63 (range: 0 - 34), respectively. The Minimal Clinically Important Difference (MCID) was achieved in 94% of cases for NRS arm pain, 77% for neck pain, and 98% for NDI. None of the follow up flexion–extension radiograms showed spinal instability. According to the modified Toyama method satisfactory radiological results, defined as stable pre- and postoperative lordosis or straight spine or change toward lordosis were found in 37 (80%) patients in our series. Unsatisfactory results, defined as stable pre- and postoperative kyphosis or change toward kyphosis were found in 8 (17%) patients. This group included 3 patients with pre- and postoperative stable kyphosis, 3 patients who worsened their cervical alignment towards kyphosis after surgery, and 2 kyphotic cases despite subsequent ACDF on the same level. Multilevel degenerative disk disease (mcDDD) were found in all 8 (100%) cases with unsatisfactory radiological result, and only in 3 (8%) cases out of satisfactory group (p=0.001). Follow-up NDI scores, but not MCIDs, were significantly worse in patients with preoperative kyphosis (18.75 vs. 10.20; p=0.03) or mcDDD (17.17 vs. 9.78; p=0.024) compared to other patients.

Conclusion: Patients with preoperative kyphosis or mcDDD had worse NDI outcomes, but they also benefitted from PF. The mcDDD may play more important role than preoperative sagittal balance as a predictor for kyphosis persistence in long term after PF.